Health-care settings hit hardest by health-professional shortages — such as rural safety-net hospitals and neighborhood community centers — are among the most likely to be served by foreign-born doctors and other providers, thanks to visa programs that encourage them to do so. In a new era of proposed travel bans and restrictions, here’s a glimpse at the impact of foreign health providers on U.S. patient care.
[See: 11 Ways Rural Life Is Hazardous to Your Health.]
From Baghdad to Richmond
Dr. Jawad Al-Khafaji practices in the U.S. in the health professional shortage area of Richmond, Virginia. He’s there through a special visa program to improve care in needy U.S. areas. Al-Khafaji covers the night shift as a “nocturnist” at the VCU Health System. Night shift is always a hard sell for hospitals trying to recruit physicians. And many patients have nowhere else to go.
“VCU is a safety-net hospital, so we serve the majority of central Virginia,” Al-Khafaji says. He and the medical residents under his supervision provide care for the internal medicine, hematology, oncology and digestive health services — about 100 patients a night.
Al-Khafaji also works part-time treating another often-overlooked group — U.S. military veterans — in the emergency room at the Hunter Holmes McGuire VA Medical Center.
Born in Baghdad, Al-Khafaji went to Weill-Cornell Medical College in Qatar for his training. As part of that Ivy League program, he did clinical rotations in New York City. He took U.S. medical boards and says he had to score much higher than U.S.-born candidates to compete for residency positions. “We just don’t have the luxury of failure,” he says. “Financially, I can’t just get a loan and take a course again. That wasn’t an option for me. It’s either pass with a high grade or go back to Iraq.”
Visa Exchanges
Al-Khafaji practices in Virginia by virtue of his H-1B visa status, fulfilling a J-1 waiver commitment. The J-1 visa is granted as part of an international program to foster global understanding through cultural and educational exchange. On completion, exchange visitors are expected to return to their home country to share their experiences.
Foreign physicians training in the U.S. through a visa program must go home for two years. However, some can get a waiver. One avenue is the clinical waiver program offered by the U.S. Department of Health and Human Services. Through it, for example, a physician must work in the most medically needy areas, like a federally qualified health center.
For medical trainees, the long-running Conrad Waiver Program allows states to provide up to 30 medical graduates the chance to work three years in a medically underserved area instead of going home.
“To get accepted into our residency programs, you really have to be in the top of your field,” says attorney Sarah Peterson, head of the SPS Immigration law firm in Minneapolis. “Just to get in, they have to be the best and the brightest … It’s a minimum three-year investment. If they’re subspecializing it can be seven or eight years. So they’re really committed to staying here.”
Immigrant Talent Pool
Travel across borders by physicians helps the U.S. medical community provide clinical care to patients, and also contributes to research and training programs, says Dr. Ali Azizzadeh, chief of vascular and endovascular surgery at McGovern Medical School at UTHealth in Houston.
“We select the most qualified and talented candidates, regardless of their race, gender, religion or national origin,” Azizzadeh says. “This fosters an environment of innovation collaboration and advancement.” Born in Iran, Azizzadeh, who came to the U.S. with his family when he was 13, is a naturalized American citizen.
[See: 11 Things Seniors Should Look for in a Health Provider.]
The Immigrant Doctors Project, a collaboration between 10 economists trained at Harvard University and the Massachusetts Institute of Technology, used data from Doximity, a social network of doctors in the U.S, to estimate how the most recent proposed travel ban could affect the delivery of health care services. Among their findings:
— More than 7,000 doctors from the six targeted countries work in the U.S., and 94 percent of Americans live in a community with at least one physician from a country that would be affected by the proposed travel ban.
— These physicians provide 14 million doctors’ appointments annually, including 1.2 million appointments per year in Michigan, 800,000 in Ohio and 700,000 in Pennsylvania.
A comprehensive report published in June 2016 by the George Mason University Institute for Immigration Research and the Immigrant Learning Center summed up contributions in specific professional fields:
— 28 percent of physicians and surgeons practicing in the U.S. are immigrants.
— 46 percent of foreign-born doctors pursue internal medicine, where a vast shortage exists. By contrast, 15 percent of U.S medical graduates do so.
— 15 percent of registered nurses are immigrants.
— 22 percent of nursing, psychiatric and home health aides are immigrants.
Travel Fears
Security and other issues would make it difficult for Al-Khafaji to travel to Iraq, he says. “My family is back home in Baghdad — I haven’t seen them for six years,” he says. “There are a lot of us who are afraid to leave this country to visit our families just because we’re afraid we might not be able to come back in.”
As executive orders on travel bans take shape, it’s unclear whether Iraq will make a final cut. This uncertainty is hard to live with, Al-Khafaji says. “When we come here, we already go through extreme vetting,” he says. “I’ve been in this country for six years. I work in two reputable hospitals in Virginia. I’ve taken care of thousands of patients. I’ve taught a lot of medical students and medical residents. You’ve already accepted me here — you’ve let me live here.”
His wife, a nurse practitioner, was born in Alaska. However, travel concerns affect them both, Al-Khafaji says: “We couldn’t go out for the honeymoon we had planned.”
Welcoming Health Workers
Welcome Back Centers assist internationally trained health care workers who have moved to California and are seeking professional credentials. They, in return, can help fill a growing need for linguistically and culturally competent health care in many parts of the U.S.
Community-based health centers in San Francisco, whether in the Mission neighborhood serving pregnant women in a primarily Spanish-speaking population or the center in Chinatown, are just two such essential facilities, says José Ramón Fernández-Peña, director of the Welcome Back Initiative and associate chair of the department of health education at San Francisco State University.
In addition to more nurses, social workers, nutritionists and health educators are also needed to make these centers work. “It’s paramount, because without that kind of staffing, they cannot provide comprehensive perinatal services,” he says. “If you go to Chinatown and you do not have a nurse, or medical assistant or somebody who can communicate in Cantonese, then you essentially have no services for the community.”
Of the health professionals involved with the Welcome Back program, the majority are probably practicing below the training they received in their countries of origin, says Fernández-Peña, who is a co-author of the 2016 report.
[See: 14 Things You Didn’t Know About Nurses.]
American Dream
Al-Khafaji’s employers at VCU have worked “diligently” to secure his visa, he says, and next year he’ll be promoted. Through his part-time employment at the VA hospital, he says, “We serve a lot of veterans who served in Iraq. We swap stories and bond so well.”
However, Al-Khafaji says he and other foreign-born professionals are “collateral damage” when it comes to proposed immigration revisions. “The U.S. is the land of innovation; the land of immigrants; the land of welcoming people,” he says. “You’re not the same as other countries — you’re supposed to be the American Dream, the No. 1 in the world.”
More from U.S. News
How Social Workers Help Your Health
Which Practitioner Do I See, and When?
Which Medical Screenings Should You Have in 2017?
How Foreign Health Providers Impact U.S. Health Care originally appeared on usnews.com
